培美曲塞联合含铂方案化疗对非小细胞肺癌患者外周血淋巴细胞表型的影响

目的探讨培美曲塞（pemetrexed）联合顺铂（cisplatin）或卡铂（carboplatin）治疗方案对非小细胞肺癌患者外周血淋巴细胞表型的影响。方法45例经病理学或细胞学确诊的非小细胞肺癌患者，采用培美曲塞500 mg/m2，第1天静脉滴注；顺铂25 mg/m2，第1～3天或卡铂按AUC=5计算剂量，第2天静脉滴注，21天为一周期，毎例患者至少治疗2周期，有可测量病灶者进行疗效评价。应用流式细胞仪检测化疗前和化疗后第7天外周血CD3+、CD4+、CD8+、CD16+56+、CD19+细胞的百分率和CD4+/CD8+比值。结果非小细胞肺癌患者经培美曲塞联合含铂方案化疗后CD4+、CD4+/CD8+、CD16+56+较化疗前升高（P=0.032），CD3+、CD8+、CD19+化疗前后差异无统计学意义（P>0.05）；临床分期为ⅢB～Ⅳ期的患者化疗前CD3+、CD4+、CD4+/CD8+和CD16+56+较ⅠB～ⅢA期患者低（P=0.029），化疗后两者比较差异无统计学意义（P>0.05）；化疗有效者CD3+、CD4+、CD4+/CD8+比值均显著增高（P=0.008）。结论非小细胞肺癌患者，尤其是晚期患者机体免疫功能低下。培美曲塞联合含铂方案化疗打破了原有的抗肿瘤免疫抑制状态，机体有可能通过免疫重建增强抗肿瘤免疫应答。

Effects of Radiation Therapy Based on Pemetrexed Combination with Cisplation or Carboplatin Regimen on Peripheral Lymphocyte Subsets in Patients with Non-small Cell Lung Cancer

Objective
To evaluate effects of radiation therapy based on pemetrexed combination with cisplatin or carboplatin regimen on
the peripheral lymphocyte subsets in patients with non-small cell lung cancer(NSCLC).MethodsA total of forty-five
patients with a pathologic diagnosis enrolled in this study were treated with pemetrexed 500 mg/m2 infusion on day
1 and cisplatin 25 mg/m2 infusion on day 1 to 3 or carboplatin area under the curve(AUC)5 infusion on day 2.The
peripheral blood was collected before and five days after chemotherapy.Every patient must be evaluated with the
flow cytometry for CD3+,CD4+,CD8+,CD4+/CD8+,CD16+56+ and CD19+.ResultsThe expressive rates of CD4+,CD16+56+ and
CD4+/CD8+ in peripheral blood in post-treatment patients were higher than that in pre-treatment samples
(P=0.032).No evident case of changes of CD3+,CD8+,and CD19+ positive cell percentage were observed after
chemotherapy(P>0.05).Before chemotherapy,the positive percentage of CD3+,CD4+,CD16+56+ and the ratio of CD4+/CD8+
in NSCLC ⅢB～Ⅳ clinical stage were statistically significantly lower than those in ⅠB～ⅢA clinical stage
patients（P=0.029）,but were not different from those after chemotherapy(P>0.05).CD3+,CD4+ and the ratio of
CD4+/CD8+ in the effective group were highter than those in pre-treatment samples（P=0.008）.ConclusionThe immune
function of advanced stage NSCLC patients is evidently suppressed.Pemetrexed combination with cisplatin or
carboplatin regimen for NSCLC may break up anti-tumor immune suppression,then a transient immune suppression
condition is reversed by the body rebuilding to enhance the immune function.